FREQUENTLY ASKED QUESTIONS
What is the best way to set up/ schedule an appointment?
Phone or email is the best way to reach us. Phone is 212-759-1383. Email to firstname.lastname@example.org. We typically are able to respond within a few hours. Letting us know a preferred day or time of day for an appointment helps with scheduling. We have early morning and evening appointments available to accommodate a variety of schedules.
Do you run on time?
We like running on time. It makes our day go smoother and it respects your time. We are aware that you make arrangements to take time out of your day to come for your appointment. To help ensure that we are timely, we schedule our appointments to allow for enough time to provide thorough and quality care so that we are not rushing. Typical wait times are under five minutes. On occasion, however, emergencies arise or treatment is more involved or is prolonged and it is difficult to rush and stop midway. When this occurs, we reach out to our patients to apprise them of the scheduling delay and work with you in either coming later or rescheduling. If we have made a patient wait in the past, we designate their chart so that we can see to it that we avoid a repeat occurrence. We strive to be timely. On the flip side, we ask for as much advance notice for changes on your end and that you try to arrive on time as it can impact our scheduling of the patients that come after you.
What about finances? Do you accept dental insurance?
We are aware that dental expenses can make a dent in your budget. We are also committed to delivering the best in dentistry. We try to balance both concerns. While in network with a few insurance plans, we do accept all PPO (preferred prover option) plans and we try to help you maximize dental benefits. We will process your claims for you. We do NOT accept DMO plans. We are always willing to work out payment plans in advance. We also accept all forms of payments, cash, check and credit card. Bear in mind, avoiding preventive care can end up becoming the most costly.
I tend to get nervous going to the dentist. Is there anything you do to help patients like me who are nervous?
You are not alone in your concern. Letting us know in advance your apprehension and concerns goes a long way in making for a more pleasant visit. Your input is definitely helpful to us. Sometimes it is as simple in knowing that we are aware of your nerves that can make the difference. We try not to rush should you need time to become comfortable. We also offer noise canceling headphones to dramatically reduce any annoying sounds of the drill. A massage feature on our dental chair, blankets and pillow all lend to a more comfortable experience.
My teeth are sensitive during cleanings. Can anything be done to minimize this?
We offer a topical gel that is painlessly applied to the gumline. This creates a mild to moderate numbing sensation in the gums for about 20 minutes. For highly sensitive or inflamed gums we offer local anesthesia to get the gums more profoundly numb. In addition, we either lower the setting on or avoid using the cavitron device (resembles a water spray) for those with extra sensitive teeth.
Can you describe how you make sure everything is clean and sterile in your office? What do you do to ensure safety?
We share your concern. Keeping things sterile is hugely important to us. We are committed to meeting or exceeding the standard of infection control mandated by OSHA, CDC and the ADA. Not only is it ethical to sterilize all the instruments, but we would not want in our mouth anything that is not sterile.
The protocol we use to ensure sterility is as follows:
We separate out our instruments that can be soaked from those that cannot (such as electric handpieces). The ones that cab be soaked are placed in an ultrasonic disinfecting solution and then thoroughly rinse them to remove all foreign matter. The other instruments are wiped with a disinfecting wipe. From there they are placed in individual bags that are sealed. These bagged instruments are then placed in an autoclave. They are sterilized using heat and steam under pressure in the autoclave, just as surgical instruments are sterilized for use in a hospital operating room. An autoclave is basically like an oven that has high heat and pressure in which microscopic organisms cannot survive.
For the remaining items that cannot go into the autoclave, such as plastic items or materials, we thoroughly wipe twice with a disinfecting wipe. We also use a disinfecting wipes on all other surfaces such as counter tops. We also use disposable items when indicated. For the dental chair, we place barrier tape on the commonly touched areas. We use barrier tape and plastic sleeve cover on any delicate items or hard to clean surfaces.
It is important to me knowing I am going to a dentist who is up to date in their field. How do you stay up to date? How do you stand out when it comes to technology?
I regard continuing education as essential to offering the best in patient care. Plus, it furthers my passion for dentistry. Being located in New York City has the advantages of providing access to many highly reputable and world renowned lectures and study groups and making it more convenient to develop strong professional relationships. Along with staying abreast of the literature, I stay current by belonging to professional organizations and regularly attending conferences, seminars, study groups as well as continuums, such as at the Pankey Institute. I also fully embrace proven technologies that will enhance patient care both in outcome and experience. Among some of the advanced technology we offer are: digital x-rays, intra-oral cameras, digital scanning, diode laser and Tekscan for bite dynamics evaluation. Our selection of materials which is representative of a firm understanding of tooth structure, dental materials and their interactions reflects a commitment to offering our patient’s the best options available in dentistry.
Do you see children?
We enjoy seeing children! It is nice when it becomes a family affair and children can come along with the parents and adopt good oral health habits early on. Our office is equipped for routine care consisting of checks ups, preventive care, sealants, fillings, bonding chipped teeth and simple extractions. When dental treatment is extensive and/or there are growth or behavior concerns, a pediatric dentist is more suitable.
What can I do at home to ensure my teeth will be in the best condition?
Good homecare is essential! The standard recommendation is brush two minutes twice a day and floss daily. I always recommend to first rinse with water. What this does is to reduce the amount of acid in your saliva. This way you avoid brushing any residual acid onto your teeth which would otherwise thin the enamel. Then brush for two minutes angling the brush towards the gumline. Next is to floss. Curve the floss to hug one side of the tooth and slide the floss all the way under the gums til you can’t go further, then lightly “scrape” the side of the tooth, repeat on the other side of the adjacent tooth. Note if you do not bring the floss all the way under the gum line, the areas you just flossed will become recontaminated making your efforts almost futile. A mouth rinse may also be useful depending on your needs. For those whose gums bleed easily, I recommend either Listerine in the morning or a warm salt water rinse. If you experience dry mouth, I recommend Biotene rinse. A fluoride rinse- such as ACT- helps when you are prone to decay or have gum recession.
What are the best foods for my teeth? Any to avoid?
Crunchy foods such as celery, apples, carrots and nuts are regarded as nature’s toothbrushes. I would recommend that you try to have a crunchy food at least once a day, midday in particular. Cheese helps to elevate the pH in the mouth. This means less tooth weakening acid. So that is another tooth friendly food. Water is another must as it helps neutralize acid and clear away debris. I would strongly recommend to stay away from soda and sports drinks. Between the high sugar and acid content these a very damaging. Sugar free versions of these drinks are still damaging owing to the acid content. It is the acid that ultimately leads to decay and thinned out teeth. Also, as a rule of thumb, the longer something is in your mouth, the more potential is has to weaken your teeth. As such you’d want to limit dried fruit and hard candies.
What role does professional dental care play in my health regimen? What are the benefits of visiting the dentist?
There are multiple benefits in visiting the dentist. By vising the dentist, you help to reset your teeth so they are clean again. In addition, your mouth will be evaluated for the following: the health of your gums, the condition of your teeth and any dental work, decay, tooth wear, occlusal/bite discrepancies and any oral pathology including oral cancer. Most dental problems are very manageable when addressed early and can become very involved and problematic to treat if not treated early on. This is a point that cannot be emphasized enough. Regular visits are so critical in this regard. Further, by visiting the dentist you have a chance to address any aesthetic concerns.
I recently had a baby and she is now getting teeth. How should I care for my child’s teeth?
Let me start by saying that baby teeth are important. They hold the spot for the grown up teeth to erupt into. Also important to mention is that the enamel of baby teeth is egg shell thin. What this means is that a small cavity can quickly advance deeper into the tooth towards the pulp. Should the pulp become contaminated, there is the very real possibility that the developing adult dentition can become exposed to the infection and become discolored. So as you can see, it is important to care for the baby teeth. As soon as your child has teeth, you want to brush them twice a day using a speck of fluoride toothpaste. For age 2.5 and under use about half the size of a grain of rice. For above age 2.5, use the size of a green pea. Fluoride in the toothpaste is very important. Too much, however, can make the child nauseous if they swallow it and can lead to fluorosis- a discoloration of the adult teeth as they are forming. Diet also plays a role in dental health. When age appropriate and not a choking hazard, you want to have crunchy foods daily and limit any sticky foods. Avoid juices. Otherwise dilute with water and serve infrequently. Also, do NOT put a baby to bed with a milk bottle as it increase the risk for baby bottle decay. The recommendation by the American Academy of Pediatric Dentistry is for a baby to see the dentist by their first birthday.
What is a typical exam like?
All exams are conducted with the mindset of how we can ensure the best dental health for you for the long term. Systematic and thorough is our approach with exams. After taking any recommended/ indicated x-rays, we evaluate all aspects from teeth, gums, soft tissue, bite, jaw joint and facial muscles. Depending on the findings, more in depth evaluation or follow ups may be recommended. We incorporate patient education in our exams because we want you to have an understanding of your health and because it helps in partnering with you to achieve the best outcome.
What does a cleaning entail?
We often start with by using a cavitron- which is a water spray- to loosen any accumulation of plaque and tarter from the teeth. Next, we use a scaler to go in the corners of the teeth and below the gum line to remove any remaining build up and ensure the tooth surface is smooth. We finish by using pumice paste with fluoride to polish the teeth. Then if, indicated, we may use a prophy jet to sandblast any nooks and crannies and remaining stains
What is a dental or gum pocket?
A periodontal pocket is the space or crevice between tooth and gum. When the gums become inflamed and puff up or when the gums “peel” away from the teeth, the pocket is deeper. This is not a good thing. Much like you can keep things in your pocket, a gum pocket can keep plaque. The deeper the pocket, the more of the bad plaque it can contain. That is why we like shallow pockets. Not to mention shallow pockets are much easier to clean. Regular professional cleanings and good home care that includes flossing go a long way to help ensure that pockets are kept shallow.
What is gum recession?
Gum recession aka “long in the tooth” is when the gumline recedes or “drops” away from the crown of the tooth leaving the root exposed. Thin and/or inflamed gum tissue, thin bone, aggressive tooth brushing and a non harmonious bites can all contribute to gum recession. I always remind my patient’s to regard their teeth as a fine crystal and act as if you are brushing a tomato vs scrubbing the floor. It is important to note, that when you have gum recession, your teeth may be more sensitive as they are now exposed and your roots may be susceptible to decay. Because of this, it is not a bad idea to add a fluoride rinse into your nighttime routine.
Why do I need a crown and what is the process like?
A crown (also referred to as a cap) is indicated when there is a large filling or there are concerns about a tooth cracking. Two visits are needed. At the first visit, we focus on three things: (1) the tooth is prepared- shaved down to accommodate the thickness of the crown, (2) the mouth is scanned- a digital impression and (3) the tooth is provisonalized- a temporary made. You then go home with a provisional/temporary crown. While you can eat about 90% as typical, you must be mindful that it is temporary and try to avoid using that tooth to eat anything sticky or chewy (such as bagels or steak). At the second visit- after an intervening 2 weeks- the crown is inserted and the fit, color and bite are evaluated. We make sure that the seam of where the crown meats the tooth- aka the margin- is tight. Crowns should not have a gap or be too bulky. The crown is then permanently cemented in. We recommend for the first 24 hours that you avoid having any hot or chewy food and hold off on flossing that tooth so that the cement can achieve its final set.
I have been told I will need a dental restoration. What does that entail and what should I expect?
When a tooth becomes compromised- decayed or broken, it needs to be restored. There are two main approaches: direct and indirect. Either the restoration is fabricated in the mouth (the direct approach) or outside the mouth in the lab (the indirect approach). By and large, the amount of good tooth left determines whether or not a lab restoration is made. Another consideration is the proximity to the gum line.
Composite bonding is the most common direct restoration. The composite material, which is a mixture of mostly resin and silica, is bonded and linked into the tooth’s substructure. Composite has a track record of being a reliable choice, is aesthetic and easy to repair. Alternative filling materials are amalgams and resin modified glass ionomer (RMGI). Amalgams were the traditional way to fill a tooth. While they are very durable, they are rarely used now as composite material has advanced and is now just as durable. Plus, amalgam has a significant drawback of contributing to tooth crazing- the prelude to cracks on a tooth. Resin modified glass ionomer (RMGI) is a great choice when decay is under the gums or on the roots.
Crowns, onlays, inlays and veneers are all examples of indirect fillings. Materials for lab made restorations include gold, porcelain fused onto metal (PFM) and porcelain/ ceramic. Gold is considered the best material to use. It is very compatible with the properties of tooth structures, its surface is smooth against the opposing teeth and it can be burnished to have a very tight seal. The only main drawback is the appearance. Although, it was once considered fashionable. PFMs have a proven track record, yet their aesthetics can be lacking as it is hard to replicate a tooth’s inherent opalescence when there is a dull metal substructure. Porcelain/ ceramic material allow for a better transmission of light and therefore, have better aesthetics. Improvements in the strength of ceramics have made them a more reliable and common approach nowadays.
It seems like there are different ways to fill a tooth. How come?
Deciding among different ways to restore a usually depends on how much good tooth is left and how durable an option you are seeking. The more compromised a tooth is, the more likely the filling will be an indirect one- made in the lab. Additional, criteria are will the filling material stay in the tooth, do we have access to adequately seal the tooth, will it last and are aesthetics a concern? Just like there are different ways to get around town from a taxi to the subway, there a different ways to fix a tooth.
Post op: After treatment care. What should I pay attention to after I just had a dental restoration?
My 3 main mentions are (1) hold off on eating til after the anesthesia wears off. This is especially true if you had the lower jaw numbed. (2) You may want to consider a softer diet for the next 24-48 hrs just so that jaw can recuperate especially if you had a long visit. (3) Please be aware of any changes in your bite. A slight “different” feeling is considered normal the first 2-3 days after a filling. This is because the mouth has been open for an extended time period and because there may be some residual adhesive on the tooth. This should resolve on its own in a few days. However, if the filling/ restoration itself was overbuilt, this needs to be reshaped so that it fits harmoniously in the mouth. It is important to not that it will not “settle into place”.
What are the ways to replace a missing tooth?
There are three ways:
(1) Removable denture. This is one of the quicker and less expensive ways to replace missing teeth. If you have some teeth remaining, the denture will typically have clasps (hooks) that grab onto some of the remaining teeth. We call these partial dentures (you have part your teeth and part denture teeth). Complete dentures are when you are missing all your teeth. Dentures usually take 2-5 fittings to fabricate. While, as mentioned, they can be quicker and less costly, they have the disadvantage of needing to put them in and out of your mouth. Also, because partial dentures hook onto your remaining teeth, they may put additional stress on those teeth. Another concern is that as your jaw resorbs over time, the denture may be less secure. Nowadays dental implants (a titanium screw in the jaw bone) help address some of the limitation of dentures. With implants, dentures are more secure. Options include placing snaps on the implant and the undersurface of the denture to snap the denture in or a bar over the implant to either clip or screw the denture into place.
(2) Bridge. A bridge consists of crowns placed over the teeth adjacent to the missing tooth area that are fused to what we call a pontic- a replacement of the missing tooth or teeth. The bridge is permanently cemented onto the teeth. A bridge has the advantage of being fixed in your mouth- you do not need to take it on and off. Some things to consider, however, is that the adjacent teeth are incorporated in the design, and as such, they are prepared/ shaved down for crowns and that your will need to use a special technique to floss under a bridge using a floss threader (similar to a needle and thread). Also, the cost involved equates to at least three crowns.
(3) Dental implant. This is the closest way to getting a tooth back. A dental implant is a titanium screw fused to your jaw bone that acts to replace the root of your tooth. It is placed by a surgeon where the bone is the healthiest and at the correct angles. After your jaw bones fuses into the grooves of the implant screw, a process called osseo-integration that can take four-six months, it is then time to restore the dental implant. That is where we come in. We will take impressions that will allow the lab to fabricate both an abutment (a typically metal piece that resembles a top hat which screws into the implant and sticks out over your gum) and the crown which is either cemented or screwed into the abutment. So when replacing a tooth with an implant, three components are involved: the implant, abutment and crown. The grand total cost for all three parts is similar to that of a bridge and you have the added benefits of leaving the neighboring teeth alone, being able to floss as typical and preserving your jaw bone. As mentioned when discussing dentures, a dental implant can be used to secure a denture. In those cases, a crown is not made and instead the abutment is modified to help anchor the denture in.
My teeth seem to be sensitive to the cold. What does that mean?
Cold sensitivity is typically associated with gum recession and exposed roots. It can also be a sign of the start of a cavity because the enamel has a hole and air can penetrate
Sometimes after chewing, I get a lingering throbbing feeling on my tooth. What could be going on?
A high bite could be to blame. We call this an occlusal discrepancy. When the tooth has an extra bump, the force of the jaw muscles bear down of the one tooth vs all the teeth resulting in pulpitis. Pulpitis is an inflammation of the pulp- the soft tissue in the inside of a tooth- which results in a throbbing or pulsing feeling in the tooth. By adjusting the occlusal discrepancy on the tooth to remove the overbuilt part of the filling, the pulp is no longer bothered and the tooth tends to "settle down".
Sometimes after chewing, I get a sharp pain, what does this mean?
Sharp pain on biting is usually indicative of a crack on the tooth. It is important to have it looked at. If left untreated, the tooth can crack and split in half needing to be extracted. Treatment usually consist of a crown, which helps act as a brace or belt around the tooth to prevent the crack from widening.
It seems like whenever I drink something hot, I get an intense pain in my tooth. What could that mean?
Sensitivity to hot is a clue to pulpitis- an inflamed pulp because of trauma or a deep cavity. Likely the tooth will need a root canal.
Why do my gums bleed? I floss.
Likely you have calculus build up which, in essence, is like spikes or barnacles on the teeth that press into the gums making them sore. Plus, calculus has a toxic composition causing the gums to bleed. This build up will constantly hurt the gums and cannot be removed by flossing. You will need to see the dentist for a scaling.
I have been grinding on my teeth. Is this a problem and what causes it?
The answer is yes it is a problem. Left untreated, grinding on your teeth (bruxism) can cause your bite to collapse, reducing the height of the lower third of your face which accelerates the appearance of aging and puts more stain on your facial muscles and jaw joint. When teeth wear down, they do not “grow back”. As tooth wear progresses, it can accelerate as the soft dentin becomes exposed and teeth can become more sensitive and prone to cracking. Causes behind bruxism include stress, overstrained muscles, a misaligned bite, occlusal discrepancies (certain parts of the teeth do not line up or are in the way when biting and moving your jaw) and a general predisposition to grinding. We can manage bruxism with an occlusal guard and/or with a bite adjustment. Physical therapy for your facial muscles can also be helpful.
My teeth appear to be shifting. Why?
As people age, there is a tendency for teeth to drift forward causing the lower teeth particular to overlap and stick up. The unfortunate consequence of this is that the upper teeth can then become chipped and worn. Should you notice this occurring, it is good idea to nip it in the bud with a retainer or Invisalign® treatment.
Lately, I feel like I have dry mouth? Why is this and what does it mean?
Medication, getting older, history of radiation are reasons for dry mouth. Dry mouth can really be detrimental to your teeth and gums. The plaque sticks around more and decay grows more rapidly. Ways to get a handle on dry mouth include: drinking water frequently, using a nightly fluoride rinse and using products for dry mouth such as Biotene.
Why do wisdom teeth need to come out?
When wisdom teeth are positioned funny, they can be difficult to clean which can compromise the adjacent tooth. With evolution, people’s jaws have been getting smaller. Consequently, there is less room for the wisdom teeth to fit in and they can end up being malposed.
What can I do to keep my teeth white? Compared to pictures from when I was younger, my teeth don’t look as white? Why is this and what can I do about it?
There are three approaches to whitening your teeth.
1) Over the counter: I recommend this method when you are toying with the idea to bleach your teeth as it can be very “hit-or-miss”. Basically, a clear band-aid like strip with a weaker concentration of bleach gel is placed against the teeth for 30 min twice a day for 10-14 days.
2) Bleach trays: A thin mouth guard like tray is custom fitted for your mouth using a mold of your mouth from an impression. Gel is applied to the inside of the tray that corresponds to the front surface. The trays are worn either nightly or 1 hour a day if using a higher concentration for 10-14 days.
3) In office whitening: After placing protective gel on your gums, a strong concentration of bleach gel is applied to the teeth. A light activates the gel. After 15 minutes, the gel is rinsed and then reapplied for about three more 15 minute session. Treatment time all together is about 75minutes. A follow up of about three nights with a bleach tray is recommend to maximize the results.
Some general points when it comes to bleaching: (1) You will experience some sensitivity- a zinging feeling in the teeth and a soreness in the gums. Everyone has different responses. Using toothpaste for sensitive teeth a week prior to starting in on and during the bleaching process is helpful. You may even need to break up the number of days of bleaching, for example, 3 days on 1 day off. Alternatively, you may need to go with a lower concentration of gel. (2) You may have some immediate relapse. Some of the whitening is attributable to the a drying effect that is transient. When that clears away, they teeth are just a little less white. So you may need to bleach for an extra day or two. (3) Everyone responds differently. For some people they may get very nice results in five day and for other it may take four weeks. Those with grey teeth may not be able to fully whiten their teeth. They will then need veneers if they desire very white teeth. (4) You will need to maintain the results. Your teeth will not stay white. If you think about it, your diet, such as coffee, wine, soda and berries, can stain your teeth. The good news is that if you monitor the whiteness of your smile, it is not as involved to keep them white as it was to get them white. Usually 1-2days of whitening every six months is enough to do the trick. (5) Any dental work (bonding, veneers and crowns) will not respond to bleaching. As such, you may end up with a mismatch in color and will need to have your dental work replaced.
I have a crooked tooth that has always bothered me. Can something be done about this?
Yes! Invisalign® is something we offer that easily correct this. Invisalign® is a series of clear aligners (thin trays) that gently nudge your teeth into the correct position. The patient is to wear the aligners 22 hours a day switching to anew one once every 1-2 weeks. The Invisalign® process consists of the following: A scan and photos are taken of your mouth. That information along with our treatment objectives are sent out to the Invisalign® company. From there a treatment plan called a Clin Check detailing movements and any adjustment needed to the teeth is created. The Clin check shows the progression of your teeth from their current state to the desired position. It will also represent the number of aligners and any needed attachments and IPR. Attachments are bonding on the tooth’s front surface that facilitates tooth movement during treatment. IPR (interproximal reduction) is a light sanding of the outer enamel that slenderizes the teeth which creates more room to straighten the teeth.
I had braces when I was a teen and now my teeth seem to be shifting
This happens more often than not. Teeth sometimes will revert back. Plus, there is a tendency to mesial drift. That is why wearing a retainer is important. We offer Invisalign®- a very effective way to remedy this. The sooner you address it, the more manageable and less likely to have resultant wear or shifting teeth.
Do you do veneers and what is the process like?
Yes! Veneers are thin porcelain shells (about 0.3-0.5mm thick) that are bonded onto the front of a tooth to achieve a desired tooth shape and color. They can make a huge impact in the appearance a one’s smile. They are an especially good option when someone has worn down the edges of their teeth, their teeth are thinning or they have teeth that are just too small. Veneers can actually protect and reinforce worn down teeth. They are a relatively minimally invasive. The process involves the following: (1) A consult. Photos, impression for models of the mouth and a review of objectives are discussed (2) A preview of the results is done. Based on a wax up of an idealized version of your teeth (created from the records in step 1), we are able to show to you in provisional material what your results will look like. We then evaluate that and take in your feedback. At this point we now have a blueprint of how we would like to proceed and we can decide to proceed with treatment. (3) Teeth are prepared, an impression is taken and the teeth are provisionalized. To prepare the teeth, they are lightly shaved down. The amount of enamel removed depends on your case. If we are looking to bring your teeth forward as in when the teeth look like they are collapsing in, then we may take away almost no tooth structure as we want the veneers to be forward. On average 0.3-0.5mm of enamel is removed. An impression is then taken. A provisional is made. Since the provisional is to resemble the final results any feedback from the patient is useful. (4) Final veneers are cemented in about two weeks later.